TAG:

HCPCS codes

ACLA Sues HHS, Claims Flaws In How CMS Set 2018 Rates

CEO SUMMARY: When the American Clinical Laboratory Association filed its lawsuit Dec. 11 against the Secretary of Health and Human Services, one of its main claims is that HHS collected payment data on the clinical laboratory testing business in a manner that was deeply flawed. HHS then u…

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At Mid-Year, Labs Struggle to Get Paid for Many Tests

CEO SUMMARY: At a recent coding and billing conference, pathology and lab clients of one of the nation’s largest revenue management companies agreed that three trends have caused lower revenues since the start of 2014. One trend seen by labs involves higher deductibles and copayments fr…

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Congress’ New SGR Law Has Mixed News for Labs

CEO SUMMARY: Once again, the lab industry faces a mixed bag following passage of a new law by Congress last week. Besides the one-year fix for the SGR, H.R. 4302 also has language that may defer adjustments to Medicare Part B lab test fees until 2017 and creates a new procedure for Medica…

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Labs Have Questions about Prostate Biopsy Policy

CEO SUMMARY: How will pathology laboratories respond to the publication of revised policies in how laboratories should file Medicare Part B claims for prostate biopsies? Not only will there be a sharp drop in the reimbursement paid for a 12-core prostate biopsy, but labs may be at increas…

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Changed Medicare Policy Adds to Regulatory Risk

CEO SUMMARY: When Medicare’s National Correct Coding Initiative (NCCI) manual took effect on January 1, 2012, it contained a significant change in how prostate biopsy claims are to be coded. This change was widely overlooked by the pathology profession and even dismissed entirely for it…

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Lawyer Advises on Risk Of Prostate Biopsy Audits

CEO SUMMARY: For labs currently processing prostate biopsy cases with five or more cores and for those pathologists interpreting those cases, there is a lack of clarity about new Medicare policies. As one example, risk of an audit is significant because of recent guidance issued by one Me…

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Competitive Bidding: Once Again, It’s Back!

CEO SUMMARY: For the clinical lab industry, the concept of competitive bidding for Medicare Part B Clinical Lab Testing may be like the movie “Groundhog Day.” The hero, Bill Murray, kept reliving the same day over and over. So it seems to be with competitive bidding. In the latest rep…

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